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Fairview Commons Nursing & Rehabilitation Center

Christian Hill Road, Great Barrington, MA 01230 · Non profit - Corporation · 146 certified beds · (413) 528-4560 Medicare & Medicaid certified

Call the home — (413) 528-4560 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse/neglect citation on record (F0600) — cited Dec 2023Behavioral-health or dementia-care citation — no harm found (F0758)2 actual-harm citations$74,354 in federal fines
Insights

This home has serious findings on its record. Read them closely before you consider it.

Worth asking about
  • it has an abuse, neglect, or exploitation citation (F0600), cited Dec 2023
  • it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0607) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • it has 2 actual-harm citations
  • a high number of inspection citations overall (36) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • the CMS record shows $74,354 in federal fines (most recent 2025-07-31)
  • its independent health-inspection rating is low (1/5)
  • its payroll-based staffing rating is low (2/5)
  • its facility-reported quality-measure rating is low (2/5)

One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.

A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.

1/5
CMS overall
1 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 1 of 5
StaffingFrom payroll records (PBJ) 2 of 5
Quality measuresSelf-reported by the facility 2 of 5

Location & what’s nearby

Hospital
★★★★★ 5/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
Chp Wic1.4 mi
442 Stockbridge Rd · (413) 528-0457 · Call to confirm hours
Pharmacy
Walgreens1.2 mi
197 Main St · (413) 528-2424 · Call to confirm hours
Grocery
Park
45 Lake Mansfield Rd · Typically dawn to dusk
Place of worship

Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Overall quality measures 2 of 5
Long-stay residentspeople who live here 2 of 5
Short-stay residentsrehab / post-hospital 1 of 5

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Trend — is this home getting better or worse?

Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 1 to 2 stars. From monthly CMS archive snapshots.

Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.

Overall rating2★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased15.6%16.4%15.4%typical
Long-stay residents who lose too much weight5.0%5.1%5.4%typical
Long-stay residents with a catheter left in their bladder2.6%0.8%0.9%worse
Long-stay residents with a urinary tract infection1.9%1.8%2.0%typical
Long-stay residents with depressive symptoms30.2%15.5%6.5%worse than state — see note marked double-dagger below the table
Long-stay residents who were physically restrained0.0%0.1%0.1%better
Long-stay residents with falls causing major injury5.3%3.4%3.3%worse
Long-stay residents whose ability to walk worsened25.3%15.4%16.1%worse
Long-stay residents on antianxiety or hypnotic medication23.7%19.5%18.9%worse
Long-stay residents given the seasonal flu vaccine71.1%94.8%95.3%worse
Long-stay residents with pressure ulcers4.9%4.2%4.7%typical
Long-stay residents with worsening bladder/bowel control12.2%21.2%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table15.5%21.4%17.1%typical
Short-stay residents who newly got an antipsychotic medication3.4%1.4%1.4%worse
Short-stay residents given the seasonal flu vaccine51.5%77.7%79.4%worse
Short-stay residents rehospitalized after admission24.3%25.7%22.6%typical
Short-stay residents with an outpatient ER visit18.0%11.9%12.0%worse
Long-stay hospitalizations per 1,000 resident days1.271.881.67better
Long-stay outpatient ER visits per 1,000 resident days2.771.501.80worse

On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.

§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.

CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

60.2% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 275 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

60.2%U.S. median 51.5%
Got home and stayed home
8.5%U.S. median 10.7%
Went back to hospital
27.5%U.S. median 56.6%
Met the expected recovery
0.21U.S. median 0.31
Therapy hours / resident / day
0.06hours / resident / day
Physical therapy
0.13hours / resident / day
Occupational therapy
0.02hours / resident / day
Speech therapy

Met the expected recovery: 27.5% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 120 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.21 therapist hours per resident per day in 2026Q1 — more than 25% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 21% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

See every short-stay measure CMS publishes for this home
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF60.2%CMS range 53.6–66.151.5%Oct 2022–Sep 2024better than U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF8.5%CMS range 6.1–10.910.7%Oct 2022–Sep 2024no different from U.S.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge27.5%56.6%Oct 2024–Sep 2025CMS makes no comparison for this measure
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge14.2%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge17.5%50.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified87.1%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting97.4%100.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge95.8%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay0.6%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened1.2%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization6.1%CMS range 4.1–9.17.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs0.981.02Oct 2022–Sep 2024CMS makes no comparison for this measure

From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.

Staffing

0.32
RN hours/ resident / day
1.23
LPN hours/ resident / day
2.19
Aide hours/ resident / day
3.73
Total nurse hours/ resident / day
0.17
RN hoursweekends
56.0%
Total nursing turnover
64.3%
RN turnover

How full it usually is: this home is certified for 146 beds and averages 119.0 residents a day — about 82% occupied, or roughly 27 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.73 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.32 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.19 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 3.25 hrs/resident/day on weekends vs 3.92 on weekdays — 17% thinner on weekends. RN hours go from 0.38 to 0.17 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 56% is about the same as the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

12
deficiencies at the latest standard inspection (2025-07-31)
11
at the previous standard inspection (2024-05-15)

Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

ABCDEFGHIJKL

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

36 citations, most serious first. The 12 most serious are shown; the remaining 24 are one tap away and print in full.

  • Actual harm · Gcited before2025-07-31 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews, the facility failed to maintain an environment that was free of accident hazards and risks for three Residents (#7, #63, and #67), out of a total sample of 26 residents. Specifically, For Resident #7, the facility failed to conduct a thorough investigation and provide effective interventions and adequate supervision to prevent falls when the Resident was identified as high falls risk due to cognitive impairment, had multiple previous falls including one fall with sustained fractures, and was left unattended in the Activity Room with other residents and sustained a hip fracture requiring hospitalization and surgical intervention.For Resident #63, the facility failed to implement assistive devices and appropriate interventions/notifications during dining to reduce the risks of aspiration (inhalation of foreign materials into the lungs) for the Resident. For Resident #67, who had a history of falls, the facility failed to analyze the reason for the Resident's…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Actual harm · Gcited before2023-01-11 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY During observation, interview, and record review, the facility failed to ensure its staff provided repositioning as required to prevent the development of a facility acquired pressure injury for one Resident (#50), out of a sample of 24 residents. Findings include: Resident #50 was admitted to the facility in April 2022 with diagnoses including unspecified Dementia and protein calorie malnutrition (under-nutrition resulting from inadequate intake, digestion or absorption of protein or calories). The Resident was also diagnosed with Covid-19 in January 2023. According to a white paper, copyright November 2022, by Wound Source and HMP Global, Inc., the following pertain to pressure injury: - One of the most critical risk factors for pressure injury (also called a bedsore - an area of injured skin and underlying tissue resulting from prolonged pressure on the skin - people most at risk are those with a condition that limits their ability to change positions), is limited mobility since it exacerbates challenges in…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2025-07-31 · tag F0804 — failed to serve food at safe, palatable temperature — pattern
    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observations, and interviews, the facility failed to ensure that beverages served during meals were palatable and at appropriate temperatures on three (Unit One, Unit Two and Unit Three) out of three units observed. Specifically, the facility failed to ensure the temperature of coffee served during meals were palatable when numerous residents had expressed concerns to the Food Service Director (FSD). Findings include: On 7/28/25 from 2:00 P.M. to 3:00 P.M., the surveyor met with residents during a Resident Council Meeting, and the following was discussed: -the coffee/hot beverages were lukewarm during resident meals. On 7/29/25 at 11:22 A.M., the surveyor requested test trays for the lunch meal for Unit One, Unit Two and Unit Three from the FSD. During an interview on 7/29/25 at 11:44 A.M., the FSD said there have been complaints from residents about the temperatures of the coffee/hot water served not being hot enough. The FSD said she has explained to residents that because of safety, and by the instruction of management, they have been unable to serve the hot beverages…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2025-07-31 · tag F0880 — failed to prevent and control infections — pattern
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observations, and interviews, the facility failed to adhere to infection control standards of practice while serving meals to residents on one Unit (Unit One), out of three Units observed, and maintain a hygienically clean environment to prevent contamination and the spread of infection in the facility laundry room.Specifically, the facility failed to:1. Ensure that staff passing breakfast meal trays in resident rooms on Unit One removed personal protective equipment (PPE: items such as gowns and gloves worn to prevent the spread of infection) after providing care for one Resident on Enhanced Barrier Precautions (EBP), prior to exiting the resident's room, and did not place a previously delivered resident breakfast meal tray in the unit food truck with undelivered resident meals trays to prevent contamination and the potential spread of infections.2. Ensure that the facility laundry room was maintained in a hygienically clean environment when stagnant water, dust laden fans, and windowsills laden with dead bugs and paint chips were observed in the proximity of clean…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-07-31 · tag F0550 — failed to protect resident dignity and rights — isolated
    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observations, interviews, and record reviews, the facility failed to provide a dignified dining experience for one Resident (#140) out of a total sample of 26 residents.Specifically, for Resident #140, the facility failed to provide a dignified dining experience during breakfast and lunch meal service when the Resident was dependent on staff for assistance with meals and:-was not served his/her meal at the same time as other residents seated at the same table.-had clothing protectors applied instead of napkins before his/her meal was served. Findings include: Review of the facility's policy titled Nutrition and Meal; Meal Tray Delivery Outside of Dining Room, dated 5/2/05, indicated:-Nursing personnel will monitor residents throughout meals to ensure resident assistance is provided promptly, per individual need. Review of the facility's policy titled Residents' Rights, revised dated 10/4/23, indicated:-A facility must treat each resident with respect and dignity and care in a manner and in an environment, that promotes maintenance or enhancement of his or her quality of…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-07-31 · tag F0607 — failed to have anti-abuse policies — isolated
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to implement abuse policies and procedures when two Certified Nurse Aides (CNA #8 and CNA #2) documented a potential allegation of abuse pertaining to one Resident (#7), out of a total sample of 26 residents. Specifically, the facility failed to ensure the allegations of abuse were identified, reported within the required timeframe, and protection was provided to residents pending the outcome of the investigation, when CNA #8 and CNA #2 documented in witness statements that Nurse #4 responded inappropriately to Resident #7 after the Resident sustained a fall.Findings include: Review of the facility policy titled Accidents and Incidents - Investigating and Reporting, revised 12/29/11, indicated all accidents or incidents involving residents, employees, visitors, vendors, etc., occurring on the premises must be investigated and reported to the Administrator.The policy also included the following:-to ensure accurate reporting, timely…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-07-31 · tag F0627 — isolated
    Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, and record review, the facility failed to ensure an effective discharge plan was implemented for post-discharge care for one Resident (#130) out of a total sample of three residents reviewed for closed records. Specifically, for Resident #130, the facility failed to ensure services such as visiting nurse and therapy, were in place when he/she was discharged from the facility when Resident #130 expressed interest in having the services in place for a safe facility discharge and reduce the risk of re-hospitalization. Findings include: Review of the facility policy titled Discharge Planning, revised 1/24/25, indicated the following: -The purpose of this policy is to establish an effective Discharge planning process that focuses on the resident's discharge goals, the preparation of resident to be active participants and effectively transition to post-discharge care, and the reduction of factors leading to preventable readmissions. >The social services staff, in concert with the interdisciplinary…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-07-31 · tag F0641 — isolated
    Ensure each resident receives an accurate assessment.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, and record review, the facility failed to ensure that Minimum Data Set (MDS) Assessments were accurate for three Residents (#4, #7 and #67), out of a total sample of 26 Residents. Specifically, For Resident #4, the facility failed to ensure the MDS assessment dated [DATE] accurately indicated the daily use of hypoglycemic (medication to lower blood sugar) and antipsychotic (medication to treat mood and behaviors) medications and did not include the use of anticoagulant (medication to thin the blood and prevent blood clotting) medication. For Resident #7, the facility failed to ensure the MDS assessment dated [DATE] accurately indicated three falls that occurred since the last MDS Assessment. For Resident #67, the facility failed to ensure the MDS assessment dated [DATE] accurately indicated falls that occurred since the last MDS Assessment.Findings include: 1. Resident #4 was admitted to the facility in April 2021 with diagnoses including Diabetes Mellitus Type 1, Cerebral Infarction (stroke)…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2025-07-31 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review, the facility failed to ensure that necessary treatment and services, consistent with professional standards of practice, were provided to promote the healing of pressure ulcers for one Resident (#49) out of a total sample of 26 residents.Specifically, for Resident #49, the facility failed to:-adhere to the Physician ordered wound treatment during wound treatment provided on 7/25/25, putting the Resident at risk for potential worsening of the pressure ulcer.-review the Wound Consultant treatment recommendations made on 7/24/25 to discontinue a medicated cream, with the Resident's Primary Medical Practitioner and update wound treatment orders timely, resulting in a delay in updated wound treatment per the Wound Consultant's recommendations. Findings include: Review of the facility policy titled Skin Integrity Management effective 3/1/2011 and revised 11/15/23, indicated but was not limited to:-Policy: .It is also the policy of this facility, consistent with CMS…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-07-31 · tag F0698 — failed to provide proper dialysis care — isolated
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide care and services consistent with professional standards of practice of fluid management for one Resident (#15), out of one applicable resident receiving dialysis (process that filters waste, salt, and fluid from the blood when the kidneys are unable to work adequately) services, out of a total sample of 26 residents. Specifically, for Resident #15, the facility failed to: -Accurately monitor daily fluid intake as ordered by the Physician, when the Resident was dependent on renal dialysis, placing the Resident at risk for medical complications related to fluid overload. Findings Include: Review of the facility policy titled Dialysis Residents, Coordination of Care Of, dated May 2005, and last revised November 2018, indicated: -The nursing facility is responsible for the overall quality of care and services the resident receives and provides the services, consistent with professional standards of practices, to residents receiving…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-07-16 · tag F0655 — isolated
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on records reviewed and interviews for one of three sampled residents (Resident #1), who required the use of bilateral nephrostomy tubes (a catheter inserted directly into the kidney that drains urine into a collecting bag outside the body), the facility failed to ensure nursing developed and implemented a baseline care plan related to his/her immediate care and treatment needs related to his/her nephrostomy tubes. Findings include:Review of the Facility Policy titled, Care Planning, revised 02/15/25, included but was not limited to the following:The Facility will develop and implement a Baseline admission Care Plan for each resident that includes the instructions needed to provide effective person-centered care of the resident that meet professional standards of quality care. The baseline care plan will be developed within 48 hours of a resident's admission and will remain in place until the initial Interdisciplinary Team (IDT) Care Plan Meeting. All Physician orders inclusive of medications, diagnoses, dietary, and therapy services are considered part of the plan of care.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-07-16 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on records reviewed and interviews for one of three sampled residents (Resident #1), who required the use of bilateral nephrostomy tubes (a catheter inserted directly into the kidney that drains urine into a collecting bag outside the body) the facility failed to ensure he/she received adequate nursing care in accordance with professional standards of practice when there were no Physician's orders related to the care and treatment for his/her nephrostomy tubes. Findings include:Review of [NAME] R. [NAME] H (2019) Nursing care and management of patients with a nephrostomy, Nursing Times [online]; 115:11, 40-43) indicated (but was not limited to) the following:- Nurses need to understand how to care for and manage patients with a nephrostomy. - Nurses need to understand issues around fluid management, infection control and management of the tube and bags. - Patients with nephrostomy tubes are at risk of pyelonephritis (inflammation of the kidney, usually due to infection). They should be monitored for signs…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
Show the remaining 24 citations
  • Potential for harm · Dcited before2025-02-04 · tag F0842 — failed to keep accurate, complete medical records — isolated
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on records reviewed and interviews, for one of three sampled residents (Resident #3), the Facility failed to ensure they maintained complete and accurate medical records when the Certified Nurse Aide (CNA) Assignment Sheets (document that includes the residents' names, room numbers and a brief synopsis of resident care needs that CNAs use daily as a reference tool) and [NAME] (a readily accessible computerized document used by CNAs to quickly reference key information about a patient's care plan, allowing them to efficiently provide appropriate care during their shift), were updated to accurately reflect his/her change in ability to transfer in and out of bed. Findings include: Resident #3 was admitted to the Facility in August 2024, diagnoses included Hemiplegia (paralysis on one side of the body), Osteomyelitis (infection in the bone) of the left ankle and foot, and reduced mobility. Review of Resident #3's Significant Change Minimum Data Set (MDS) Assessment, dated 01/22/25 indicated Resident #3 was…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2024-05-15 · tag F0730 — widespread
    Observe each nurse aide's job performance and give regular training.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record and policy review, and review of the facility assessment, the facility failed to ensure that annual performance appraisals were completed every 12 months and regular in-service education was provided based on the outcome of the performance appraisals for four Certified Nurses Aides (CNAs) out of a sample of five CNAs. Specifically, the facility failed to ensure that expectations, individual performance, and training requirements were communicated to CNA #3, CNA #4, CNA #5 and CNA #6 through the annual performance appraisal process as required. Findings include: Review of the Facility assessment dated [DATE] indicated: -The facility uses competency-based job descriptions, -a competency-based assessment process for the nursing department and annual performance appraisals to identify the training the staff needs to receive and accompanying plan. Review of the facility policy titled Performance Review indicated: -The facility will attempt to maintain a performance appraisal system that is…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-05-15 · tag F0761 — failed to label and store drugs safely — pattern
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview and policy review, the facility failed to ensure that medications were labeled in accordance with professional standards to include an expiration date on two (#2 and #4) out of three observed medication carts, and on two units (Unit 1 and Unit 2) out of three observed units. Specifically, the facility failed to ensure that an ophthalmic (relating to the eye and its diseases) medication was appropriately labeled to indicate the bottle open date and/or discard date according to manufacturer's guidelines and prevent the administration of outdated medications that could result in contamination and infections for facility residents. Findings include: According to the National Library of Medicine (2022): https://www.ncbi.nlm.nih.gov/books/NBK540978/#:~:text=Latanoprost%20is%20a%20colorless%2C%20isotonic,46%20%C2%B0F)%20for%20storage, once Xalatan Ophthalmic Drops (generic name Latanoprost: eye drops used to treat high pressure in the eye) is opened, it may be stored at room temperature for 6 weeks. Review of the facility policy titled Medication Storage…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-05-15 · tag F0584 — failed to keep a safe, clean, comfortable home — isolated
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and policy review the facility failed to maintain a clean and homelike environment for one Resident (#11) on one Unit (#1) out of three units observed. Specifically, for Resident #11 who resided on Unit #1 the facility failed to ensure that the Resident's window covering was maintained in a clean manner. Findings include: Review of the facility policy titled Environmental Services Guidelines, dated September 2011, indicated the following: -Cleaning of walls, curtains, blinds, etc. will be completed when dust/soil is visible. On 5/9/24 at 10:20 A.M., the surveyor observed multiple areas of dried dark brown material and a large stain on Resident #11's window covering. During an interview at the time, Resident #11 said his/her window covering was dirty and he/she would like to have it cleaned or replaced. Resident #11 further said that he/she had not seen anyone clean the window covering recently and he/she was unsure what the spots and large stain were from. On 5/13/24 at 8:31 A.M., the surveyor observed that Resident 11's window covering remained with…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-05-15 · tag F0641 — isolated
    Ensure each resident receives an accurate assessment.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure the accuracy of the Minimum Data Set (MDS) Assessments for two Residents (#60 and #21), out of a total sample of 25 residents. Specifically, the facility failed to ensure the MDS Assessment was accurately coded relative to: 1. For Resident #60, the use of hypoglycemic medications (medications that reduce blood sugar [glucose]), antianxiety medication (used to treat feelings of fear, dread, uneasiness that may occur as a reaction to stress) and that the Resident was on dialysis (procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly). 2. For Resident #21, the administration of antipsychotic (used to treat symptoms of psychosis which include hallucinations, delusions and Dementia), antibiotic (used to treat bacterial infections), antianxiety and hypoglycemic medications. Findings include: 1. Resident #60 was admitted to the facility in October 2022, with diagnoses including End Stage…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-05-15 · tag F0657 — failed to keep the care plan current — isolated
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure that two Residents (#109 and #82) and/or their Representative, out of a total sample of 25 residents, were included in the comprehensive care planning process. Specifically, the facility failed to: 1. For Resident #109, schedule Care Plan meetings as required, and facilitate participation by the Resident and/or Representative in the care planning process. 2. For Resident #82, ensure that a Care Plan conference was held, and the Resident and/or Resident Representative was involved in the care planning process after the completion of two MDS Assessments. Findings include: Review of the facility policy titled Care Planning, revised on 10/28/22, indicated the following: -A letter will be sent to each resident or resident representative inviting them to the meeting. -Attendance: CP (Care Plan) Coordinator (Social Worker) oversees the meeting, Unit Manager, Activities Staff, Dietary, CNA (Certified Nurse ' s Aide) Rehabilitation Staff as indicated.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-05-15 · tag F0658 — failed to meet professional standards of care — isolated
    Ensure services provided by the nursing facility meet professional standards of quality.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, record and policy review, the facility failed to provide care in accordance with professional standards of practice for one Resident (#18), out of a total sample of 25 residents, with a Peripherally Inserted Central Catheter (PICC: a thin, soft tube that is inserted into a vein in the arm, for long-term antibiotics, nutrition, medications, and blood draws. The PICC is a type of CVAD [Central Vascular Access Device] catheter) placing Resident #18 at risk for undiagnosed infiltration (when fluid or medication given by an intravenous device exits the vein and enters the soft tissues) and/or deep vein thrombosis (DVT: a blood clot in a deep vein). Specifically, the facility staff failed to: -appropriately monitor the PICC device and discontinue use when external catheter length measurements varied from the admission insertion measurements. -complete external catheter length and arm circumference measurements as ordered. -notify the Provider timely when changes in external catheter length and arm circumference measurements were identified. Findings…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-05-15 · tag F0687 — failed to care for feet properly — isolated
    Provide appropriate foot care.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to provide proper treatment and care for good foot health for one Resident (#226) out of a total sample of 25 residents. Specifically, for Resident #226, the facility staff failed to assess, and assist with completing and submitting the necessary podiatry consent form to facilitate timely podiatry services to address the Resident's long toenails. Findings include: Review of the facility policy titled Consulting Services, Podiatry/Dental/Optometry/Audiology approved on 12/22/16, indicated that residents/resident representative are provided information about consulting services upon admission and at any time when need arises. Resident #226 was admitted to the facility in April 2024 with diagnoses including localized edema (a disorder that causes swelling in a specific area of the body due to a buildup of fluid) and peripheral edema (swelling in the arms, legs, ankles, feet and hands caused by fluid retention in the tissues). Review of the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-05-15 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure that one Resident (#35) out of a total sample of 25 residents, was provided with an environment that was free from accidental hazards. Specifically, for Resident #35, the facility failed to implement the appropriate size bed side rails and maintain the bed in the lowest position after the Resident sustained a fall and injury, as preventative measures for further falls and injuries. Findings include: Review of the facility policy titled Care Planning, revised on 10/28/22, indicated the following: -All MD (Medical Doctor) orders .are considered a part of the care plan. Resident #35 was admitted to the facility in March 2024, with a new diagnosis of above the knee amputation (AKA -surgically cutting off the limb) of the right leg. Review of the Fall Care Plan initiated on 3/26/24, indicated the Resident was at risk for falls due to a change in mobility/gait status post right AKA and deconditioning (physiological change following a…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-05-15 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
    Provide enough food/fluids to maintain a resident's health.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, record and policy review, the facility failed to provide nutritional care and services for two Residents (#63 and #84), out of a total sample of 25 residents. Specifically, the facility staff failed to: 1. For Resident #63, provide a nutritional supplement when the Resident was identified as being at nutritional risk due to a resolving hip fracture. 2. For Resident #84, provide an increase in a nutritional supplement as indicated for added calories, protein and hydration support from once to twice daily. Findings include: Review of the facility's policy titled Nutrition Management, dated 6/6/22, indicated the following: -Review dietitian's recommendations. Obtain orders per recommendation. -Review dietitian's progress notes to identify ongoing progress and recommendations. 1. Resident #63 was admitted to the facility in June 2022, with diagnoses including Dementia (a group of conditions characterized by impairment of at least two brain functions, such as memory and loss of judgment), and a fracture of the neck of the right femur (hip fracture)…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-05-15 · tag F0842 — failed to keep accurate, complete medical records — isolated
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to maintain complete and accurate medical records for three Residents (#8, #21 and #60) out of a total sample of 25 residents. Specifically, the facility staff failed to: 1. For Resident #8, ensure accurate documentation relative to the units of Insulin (medication used to manage blood sugar levels) administered per the sliding scale for each of the readings requiring sliding scale coverage. 2. For Resident #21, accurately administer and document the base and sliding scale units of Insulin as ordered by the Physician. 3. For Resident #60, accurately document the bruit and thrill (sounds that can be heard or felt near a dialysis site and indicate that the site is working) assessment of the dialysis access site. Findings include: Review of the facility's policy titled, Diabetic Management Protocol, dated, April 2018, indicated the following: -Document all scheduled insulin/oral hypoglycemic medication on Medication Administration Record (MAR). -Document all sliding scale insulin medication on Diabetic Monitoring Flow Sheet. 1.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-05-15 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record and policy review, the facility failed to maintain an infection prevention and control program designed to help prevent the potential transmission of communicable diseases and infections within the facility for one Resident (#112) out of a total sample of 25 residents. Specifically, the facility staff failed to clean and disinfect multi-use equipment after use on a resident prior to using the same equipment on Resident #112 who was at high risk for infection. Findings include: Review of the facility policy titled Procedure for Isolation: Initiation of Isolation Precautions dated 4/11/22 indicated but was not limited to: -If supplies go into the room, it must not be used for any other resident until it is cleaned and disinfected. -The blood pressure cuff may be cleaned with the healthcare system approved disinfectant product per the manufacturer's instructions. Review of the facility policy titled Enhanced Barrier Precautions (EBP: a type of precautions initiated to help…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-12-19 · tag F0600 — failed to protect residents from abuse and neglect — isolated
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on records reviewed and interviews, for one of three sampled residents (Resident #1), who was non-verbal, cognitively intact, understood others and was able to make his/her needs known by typing out messages on his/her cell phone screen, the Facility failed to ensure he/she was free from verbal abuse by a staff member, when on 11/26/23, at approximately 9:00 A.M., Certified Nurse Aide (CNA) #1 sent a text message to Resident #1 using language that included profanity, contained statements that were disparaging, insulting, humiliating, and accusatory toward Resident #1. Findings Include: Review of the Facility's Policy titled Resident Abuse Prevention, Investigation and Reporting, dated as revised 02/17/17 indicated the following: -It is the policy of the Facility and the responsibility of all staff to ensure an environment free of abuse, neglect, mistreatment, misappropriation of resident property, and exploitation. -Verbal Abuse: The use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
  • Potential for harm · Dcited before2023-12-19 · tag F0607 — failed to have anti-abuse policies — isolated
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on records reviewed and interviews, for one of three sampled residents (Resident #1), the Facility failed to ensure that staff implemented and followed their Abuse Policy related to the need to immediately report allegations of abuse to the Supervisor, Administrator or Director of Nurses (DON), when on 11/26/23, after Certified Nurse Aide (CNA) #3 received a copy of a text message that CNA #1 had sent to Resident #1, that contained profanity, disparaging comments, insults, and ridiculed him/her (Resident #1), CNA #3 did not immediately report it to Facility administration as required, and waited until 11/30/23 (four days later) to report, therefore placing Resident #1 and other residents at risk for abuse. Findings include: Review of the Facility's Policy titled Resident Abuse Prevention, Investigation and Reporting, dated as revised 02/27/17, indicated that all staff who suspect abuse, neglect, mistreatment and or misappropriation must immediately make an oral report to his or her supervisor. The Policy indicated the following: -All employees are responsible for identifying…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
  • Potential for harm · F2023-01-11 · tag F0725 — failed to have enough nursing staff — widespread
    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review the facility failed to ensure there was sufficient nursing staff (including Certified Nurses Aides-CNAs) to provide services and nursing care that met the needs of residents on three Units (Unit One, Unit Two, and Unit Three), out of three units observed. Findings include: 1. Review of the Facility Assessment Tool revised 1/8/23, indicated the facility had identified the range of CNAs needed to care for the residents in the facility on an average day was between 24-32. Review of the Daily Nursing Schedules from 1/1/23, 1/7/23, and 1/8/23 indicated less than the Facility Assessment identified 24-32 number of CNAs needed per day, documented as follows: -On 1/1/23: A total of 22 CNAs worked and the following shifts were affected by short staffing of CNAs: >On the 7 A.M. to 3 P.M. shift: nine CNAs worked (Three CNAs on Unit One, Three CNAs on Unit Two, and Three CNAs on Unit Three) -On 1/7/23: A total of 21 CNAs worked and the following shifts were affected by short staffing of CNAs: >On the 7 A.M. to 3 P.M. shift: eight CNAs worked…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2023-01-11 · tag F0886 — failed to test for COVID-19 as required — widespread
    Perform COVID19 testing on residents and staff.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure that its staff conducted twice weekly COVID-19 testing for staff who are not fully up to date with COVID-19 vaccinations, for three staff members (Nurse #1, Laundry Staff #1 and Activities Assistant #1), out of a sample of three staff members. Findings Include: Review of the facility policy titled COVID-19 Testing, revised on 11/10/22, indicated the following: -In compliance with local, state, and federal regulation, has a testing plan for symptomatic, surveillance, and outbreak testing . -Staff who are not up to date with COVID-19 vaccines must conduct twice-weekly testings . -Up to date we will follow the Centers for Disease Control and Prevention (CDC) definition which means the individual has received the primary series with the monovalent vaccine and the bivalent booster two months after the most recent COVID-19 vaccine dose. Review of Massachusetts Department of Public Health Memo titled Updates to Long-Term Care Surveillance and Outbreak Testing, dated December 1, 2022 indicated the following: - .Staff who…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2023-01-11 · tag F0880 — failed to prevent and control infections — pattern
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure its staff followed their COVID-19 monitoring plan to prevent the spread of infection. Specifically, the facility's staff failed to screen for signs and symptoms of COVID-19 every shift (Q shift) on units experiencing a COVID-19 outbreak for two Residents (#65 and #158), out of a sample of three residents. Findings Include: Review of the facility policy titled COVID-19 Prevention and Outbreak Management, revised 5/12/22, indicated the following: - .It is the practice .of this facility to follow the guidance of government resources including Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid (CMS), Massachusetts Department of Public Health (DPH) . -If a resident is symptomatic for COVID-19 or positive for COVID-19 or exposed to COVID-19, symptom monitoring is enhanced to every shift. Review of the DPH memo titled Updated to Caring for Long-Term Care Resident's during the COVID-19 Response, including Visitation Conditions, Communal Dining, and Congregate Activities, dated October 13,…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-01-11 · tag F0623 — isolated
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure its staff provided the required discharge/transfer notices for two Residents (#56 and #97), and/or their Representatives and the Long-Term Care Ombudsman office, out of a sample of 24 residents. Findings include: Review of the facility policy titled, Admission/Discharge/Transfer Rights, facility reviewed on 10/24/22, indicated the following: - Normally all transfers and discharges require a 30 days' notice to the resident - Exception .immediate transfer or discharge is required by the resident's urgent medical needs and this is documented in the medical record . - If exception is met, less than 30 days notice is allowed and the following forms can be used: >Discharge Less Than 30 Days >Transfer Less Than 30 Days - The facility will send notice to a Representative of the Office of the State Long Term Care Ombudsman. -Notices should be sent daily to the local Ombudsman program either by postal mail or fax. 1. Resident #56 was admitted to the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-01-11 · tag F0727 — failed to provide required RN coverage — isolated
    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
    What the surveyor found here — the official record, unedited, may be distressing

    Based on interview and record review, the facility failed to ensure that services were provided by a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. Findings include: Review of the facility policy titled Staffing in the Department of Nursing, dated 5/2/05, indicated the following: -The facility will ensure a RN is scheduled for at least eight consecutive hours a day, seven days a week. Review of the facility's weekly nursing schedule dated 12/16/22 through 12/17/22, indicated a RN was not scheduled for eight consecutive hours in a 24 hour period from 11 P.M. on 12/16/22 through 11 P.M on 12/17/22. During an interview on 1/10/23 at 2:34 P.M., the Director of Nursing (DON) said there should have been a RN scheduled for eight hours in that 24-hour period and there was not.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-01-11 · tag F0758 — failed to limit and justify psychotropic drugs — isolated
    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure that its staff monitored the use of psychotropic medications (medications that affect brain activities associated with mental processes and behavior) to promote and maintain the highest practicable mental, physical, and psychosocial well-being of two Residents (#10 and #162), out of a sample of 24 residents. Findings include: Review of the facility policy titled Psychotropic Medications, facility reviewed 10/28/22, indicated that residents receiving psychotropic medication will be monitored for the effectiveness of the medication and for adverse reaction, with the results of such monitoring documented in the resident's record. 1. For Resident #10 the facility failed to ensure its staff monitored changes or side effects for the use of Risperidone (an antipsychotic used to treat a wide range of psychiatric and neurological disorders), Trazodone, (an antidepressant) and Depakote Sprinkles (an anti-seizure medication). Resident #10 was admitted to the facility in 2013 with diagnoses including Schizophrenia and…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-01-11 · tag F0849 — isolated
    Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interviews and record review, the facility failed to ensure that its staff coordinated and provided Hospice Care services in accordance with the plan of care for one Resident (#208), out of a sample of 24 residents. Specifically, facility staff failed to: 1) communicate with the contracted Hospice to assist with symptom management resulting in prescribed medications of the same drug class being used for the Resident, and 2) ensured that the contracted Hospice provided the facility with documentation of the care and services provided to the Resident by Hospice and ensure the documentation was readily available in the Resident's record. Findings include: Resident #208 was admitted to the facility in January 2023, with a diagnosis of Intracerebral Hemorrhage (bleeding into the tissues of the brain). 1. Review of the facility policy titled, Hospice Program, revised 3/28/22, indicated the following: - Purpose: to work collaboratively with the Hospice agency to provide end of life care. - When a resident participates in the Hospice program, a coordinated care plan between the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Administration Deficiencies · Deficient, Provider has date of correction
  • No harm found · B2025-07-31 · tag F0582 — pattern
    Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview, and record review, the facility failed to issue the Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN: notice issued to a resident when a facility determines the beneficiary no longer qualifies for Medicare Part A skilled services, the resident has not used all his/her Medicare benefit days, and plans to remain in the facility after coverage has ended) for two Residents (#19 and #141) out of a total sample of 26 residents. Specifically, for Residents #19 and #141, the facility failed to issue a SNF ABN to the Resident and/or Resident Representative for notification that their skilled services may not be paid for by Medicare and what financial responsibility would need to be assumed when the effective date of Medicare Part A coverage for skilled services ended and both Residents remained in the facility. Findings include: 1. Resident #19 was admitted to the facility in May 2025 with diagnoses including Metabolic Encephalopathy, Pneumonia, and Emphysema. Review of Resident #19's Medicare Notice of Non-Coverage (NOMNC) letter indicated…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · No revisit needed
  • No harm found · B2025-07-31 · tag F0644 — pattern
    Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and interview, the facility failed to ensure that a Level II (comprehensive evaluation that identifies the specialized services required) Preadmission Screening and Resident Review (PASARR- evaluation done if it was determined by the Level I (initial pre-screening] screen that a resident had an intellectual or developmental disability and/or serious mental illness [SMI] and if a resident was in need of additional support services at the facility) screen was submitted for one Resident (#60), out of a total sample of 26 residents.Specifically, for Resident #60, the facility failed to request a Level II PASARR evaluation when the Resident screened positive for ID (intellectual Disability)/DD (Developmental Disability) during a Level I PASRR Evaluation. Findings include: Review of facility policy titled Preadmission Screening and Resident Review (PASRR), last revised dated 9/22/23, indicated the following:-Make referrals to the Department of Developmental Services (DDS) and/or the Department…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · No revisit needed
  • No harm found · Bcited before2025-07-31 · tag F0842 — failed to keep accurate, complete medical records — pattern
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, and record review, the facility failed to ensure that medical records were complete and accurate for one Resident (#76), out of a total sample of 26 residents.Specifically, for Resident #76, the facility failed to:1. ensure the Physician's Orders accurately reflected the Resident's Representative from [DATE] through [DATE], resulting in the potential risk for the Resident's confidential information to be provided to an unauthorized party and the risk for an unauthorized party to make medical decisions for the Resident.2. obtain and document in the Resident's medical record evidence of the Resident's court-appointed Guardian from [DATE] through [DATE]. Findings include: Review of the facility policy titled Medical Records Policy effective [DATE], indicated but was not limited to the following:-Guidelines: Each resident will have an active medical record. This record shall be kept current, complete and available at all times to authorized personnel. Resident #76 was admitted to the facility in…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · No revisit needed

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
  • Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
  • State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

$74,354 in federal fines across 1 penalty.

  • $74,354 — penalty dated 2025-07-31

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to INTEGRITUS HEALTHCARE — 14 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

RatingThis homeChain avg
Overall 1 of 52.8-1.8 vs chain
Health inspection 1 of 52.9-1.9 vs chain
Staffing 2 of 53.4-1.4 vs chain
Quality measures 2 of 52.7-0.7 vs chain
The other 13 homes this chain runs (chain average 2.8★, per CMS)

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

Owner / managerTypeRoleShareSince
WILLOWOOD EXTENDED CARE SERVICES INCOrganization5% OR GREATER DIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF100%since 02/01/2000
INTEGRITUS HEALTHCARE INCOrganization5% OR GREATER INDIRECT OWNERSHIP INTEREST; 5% OR GREATER SECURITY INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2000
INTEGRITUS HEALTHCARE MANAGEMENT SERVICES INCOrganization5% OR GREATER INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFNO PERCENTAGE PROVIDEDsince 02/01/2022
GINGRAS, MARCIE JOIndividualCORPORATE OFFICER; ADP OF THE SNFsince 02/01/2022
JONES, WILLIAMIndividualCORPORATE OFFICER; ADP OF THE SNFsince 02/01/1993
COBURN, KATHLEENIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 11/01/2024
MURRAY, MICHAELIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 02/01/2022

CMS files one row per role, so the 16 rows in the source record cover these 7 parties — each is shown once here with every role it holds. Nothing is omitted.

3 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

$14.0M
Net patient revenuemost recent cost report
-15.6%
Operating marginrevenue minus expenses
$1.6M
Related-party expense10% of expenses
Who pays — share of resident-days
Medicaid 62%Medicare 14%Other / private 25%

This home reported $1.6M paid to related parties — landlords or management companies under common ownership — equal to about 10% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

$388per resident / day
operating cost
$11,800per month
≈ monthly operating cost
$336per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in MA

Paying with Medicaid

This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Massachusetts Medicaid page.

Typical monthly cost in Massachusetts
$14,448/mo
Nursing home (semi-private)
$15,817/mo
Nursing home (private)
$9,600/mo
Assisted living

Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.

Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 225250. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-07-31, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

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